Florida searches for common ground on new trauma center rules

TALLAHASSEE — The fight over who gets to operate Florida's trauma centers is far from over, but a marathon negotiating session Thursday identified some common ground the Department of Health says it will use to revise a proposed rule for granting new centers.

Long-established trauma centers have tried to limit the proliferation of new ones, which has led to dozens of legal and administrative challenges.

Many of the new trauma centers are at hospitals owned by the powerful for-profit chain HCA.

Both sides have criticized portions of the Department of Health's proposal, which uses a point system and a handful of criteria to determine if new trauma centers are warranted.

Thursday's negotiation session was intended to help build a consensus among stakeholders so the DOH could finalize its rule before an April 1 application deadline for new trauma centers.

"I don't think we're that far off," DOH general counsel Jennifer Tschetter said at the end of the seven-hour discussion.

The group agreed that population, the number of severely injured patients who are treated in emergency rooms instead of trauma centers and the existence of other nearby trauma centers are all factors to include in the new criteria.

But the meeting was full of disagreement and debate about other parts of the new rule, such as a requirement that new trauma centers be at least 5 miles from existing ones.

Some members of the committee suggested the radius be increased to 10 miles. Others said the criteria should be patient transport times, not distance.

Some complained that the state's rules for determining if a patient needs trauma care make it even harder to determine need.

"Not everyone agrees on the definition of a trauma patient, which is an issue of itself," said Dr. Darwin Ang, trauma surgeon at Ocala Regional Medical Center, one of the newer trauma centers.

The group agreed that there is no solid data to track transport time but the mileage question was unsettled, too.

Despite opposition from some of the long-standing trauma centers, Tschetter said she would not remove a category that allows county and city officials to express their support for new trauma centers.

Representatives of hospitals with long-standing centers said fundraising and political posturing could be used to manipulate that process.

"No one's going to argue that we don't want a trauma center here," said Karen Putnal, a lawyer for St. Joseph's Hospital in Tampa, which has an established trauma center.

Once the DOH revises its trauma rule, there will be another round of public comment.